جستجوی مقالات مرتبط با کلیدواژه « Pulmonary Disease » در نشریات گروه « پزشکی »

Chronic obstructive pulmonary disease (COPD) and heart failure represent 2 entities of a growing global burden that share common clinical and etiological characteristics. Timely identification of heart failure is imperative for effective management. This study aimed to investigate subclinical left ventricular (LV) dysfunction by conventional and speckle-tracking echocardiography (STE) methods in COPD patients. 

This is a prospective cohort study on 46 (54.1%) newly diagnosed patients with COPD without comorbidities (formerly diagnosed with confounders for evaluating cardiac performance: arrhythmias, diabetes, old age, hypertension, renal failure, and cardiovascular or valvular disease) (46.80±4.67 y, 30 (65.2%) males), and 39 (45.9%) age- and sex-matched healthy control smokers. COPD patients were classified based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. 

Contrary to conventional echocardiographic parameters, STE revealed impairment of the LV basal circumferential strain (BCS) among COPD patients (-21.20%±3.89% vs -23.70±5.75; P=0.003) and gradually reduced with the severity of COPD GOLD (P=0.007), indicating LV dysfunction. Regarding global circumferential or longitudinal STE, COPD patients did not vary significantly (P=0.10, 0.57). In multiple linear regression analysis, spirometry parameters (FEV1(L), FEV%, FVC(L), FVC%, and FEV1/FVC) predicted BCS (P=0.023).Right bundle branch block was observed more frequently (P=0.005) and the tricuspid annular plane systolic excursion level was significantly lower (P=0.017) among the COPD group. The results were associated with the degree of COPD GOLD severity (P=0.036), indicating right ventricular dysfunction. 

COPD seems to be accompanied by impaired subclinical right ventricular and regional-level LV deformation properties that worsen in stages of COPD GOLD. 

 Obesity is a major concern that increases children's asthma risk. Obese asthmatic patients have more severe symptoms and attacks and less responsiveness to medication.

 We aimed to investigate whether obese children have more asthma attacks, severe exacerbations, and respiratory distress.

 This cross-sectional study was performed on 149 children diagnosed with asthma attacks at Taleghani Children's Hospital in Gorgan, Iran, in 2018 - 2019. The relationship between body mass index (BMI) and the severity of asthma attacks in pediatric patients was investigated in 2020. The obtained data were analyzed using SPSS-18 software. Fisher's exact test and Spearman's rank correlation coefficient were used to analyze the data.

 The mean age of the patients was 8.8 ± 2.76 years; 60.4% were boys, and 39.6% were girls. According to the BMI-age chart, 1.3% of the patients were underweight, 70.5% were in the normal range, 21.5% were overweight, and 6.7% were obese. Patients with higher BMI had more severe asthma attacks (P-value = 0.029) and respiratory distress (P-value = 0.015). In the pulmonary function testing, Forced Vital Capacity (FVC) and Forced Expiratory Volume in the first second (FEV1) were significantly lower in obese children. In addition, pCO2 and HCO3 were higher in overweight patients (P-value = 0.01 and 0.041, respectively).

 Patients with higher BMI had more severe attacks, exacerbations, and respiratory distress. Also, FVC and FEV1 were significantly lower in obese children. Obesity and asthma have many common pathophysiological mechanisms, and obesity increases the severity of asthma attacks and makes treatment challenging. Different mechanisms are involved in obese patients with asthma, including airway hyperreactivity, inflammation, and airway remodeling. Although the exact relationship between asthma attacks and obesity is still unclear, its understanding could lead to more therapeutic options.

The disposition decision is a great challenge for clinicians in managing patients with chronic obstructivepulmonary disease (COPD) exacerbation. This study aimed to evaluate the accuracy of Ottawa COPD Risk Scale (OCRS)in predicting the short-term adverse events in the mentioned patients.

This prospective diagnostic accuracystudy was conducted on COPD exacerbation cases who were referred to the emergency department (ED). Patients werefollowed up for 30 consecutive days for adverse events including the need for intubation, non-invasive ventilation, my-ocardial infarction, readmission, and death from any cause, and finally the accuracy of OCRS in predicting the outcomewas evaluated.

362 patients with the mean age of 65.55 ± 10.65 (6- 95) years were evaluated (58.0% male).Among the patients, 164 (45.3%) cases were discharged from ED, and 198 (54.7%) were admitted to the hospital. 136(37.6%) cases experienced at least one of the studied short-term adverse events. The mean OCSD score of this series was1.96 ± 2.39 (0 – 10). The area under the curve of OCRS in predicting the outcome of COPD patients was 0.814 (95%CI:0.766 – 0.862). The best cut-off point of the scale in predicting the outcome was 1.5. The sensitivity and specificity ofthe scale were 75.75% (95%CI: 69.6% – 81.42%) and 89.63% (95%CI: 83.67% – 93.66%), respectively. By employing thisthreshold, 48 (13.25%) cases would have unnecessary hospitalization, and 17 (0.04%) would be discharged incorrectly.

The OCRS has acceptable level of prediction accuracy in predicting the short-term adverse event of COPDpatients. The use of this scoring in the routine practice of ED clinicians can lead to a reduction in unnecessary admis-sions and unsafe discharge for these patients.

Background

This study aimed to provide patients with chronic obstructive pulmonary disease (COPD) with an intervention based on whole-body vibration training (WBVT), examine pulmonary function and electroencephalograms (EEGs) to improve the physical capacity of these patients, and suggest an efficient approach to managing these patients in practice.

A clinical sample of 22 patients with severe COPD was randomly assigned to either Experimental Group I (n=12), which performed squat exercises in combination with WBVT, or Experimental Group II (n=10), which served squat exercises alone. The intervention programs were administered over four weeks, with ten repetitions per set, three sets per session, one session per day, and three days per week.

In Experimental Group I, within-group changes pre-and post-intervention were significant for the alpha waves in Fp1, Fp2, F3, and F4, whereas no within-group changes in pulmonary function, EEG, or 6-minute walk test (6MWT) performance were observed in Experimental Group II. Significant between-group differences were observed in the alpha waves in Fp1, Fp2, and F4 (P<0.05).

Exercise combined with WBVT was a safe and effective strategy to counteract the loss of musculoskeletal function in patients with COPD. Additional research is needed to develop protocols for the combination of WBVT and pulmonary function intervention programs.

Cholestasis/cirrhosis is a multifaceted clinical complication that influences many organs, including the liver, kidney, heart, skeletal muscle, and lung. Cirrhosis-associated lung injury could lead to severe and lethal consequences, including acute respiratory syndrome and patient dearth. Unfortunately, there is no specific pharmacological intervention to manage cholestasis-induced lung injury. It has been revealed that severe inflammation and its associated complications, such as oxidative stress, are involved in the pathogenesis of cholestasis-associated pulmonary damage. The current study was designed to evaluate the role of dexamethasone (DXM) on lung inflammation in cholestatic mice. For this purpose, bile duct ligated (BDL) mice received DXM (1 and 2.5 mg/kg, i.p, 2 times/week) for 14 days. On day 15, the bronchoalveolar lavage fluid (BALF) was prepared. Several markers, including inflammatory cell infiltration, TNF-α, and IgG, were assessed in the BALF of BDL animals. Significant infiltration of inflammatory cells along with increased TNF-α and IgG were detected in the BALF of BDL mice (14 days after surgery). Moreover, significant ROS formation, glutathione depletion, lipid peroxidation, and protein carbonylation were evident in the lung tissue of the BDL group. It was found that DXM (1 and 2.5 mg/kg) significantly blunted inflammation and oxidative stress in the lung of cholestatic mice. Moreover, lung tissue histopathological changes, including inflammatory cell infiltration, were significantly mitigated in DXM-treated mice. These data offer the potential therapeutic effects of DXM against cholestasis-related complications. Therefore, patients with cholestasis-induced lung injury might benefit from repurposing DXM in clinical settings.

 Chronic obstructive pulmonary disease (COPD) is a common disease that causes 6% of deaths, 90% of which occur in low- and middle-income countries. Improving these patients' quality of life (QOL) is one of the primary treatment goals. The St. George's Respiratory Questionnaire (SGRQ) is used to measure the health status of patients with respiratory problems. This research aimed to assess the health status of patients with COPD after validating the Persian version of this questionnaire.

 The study was performed from Feb to Oct 2016 in Shiraz, Iran. First, the Persian version of the questionnaire was validated using a back-translation technique by two translators, supervised by two researchers, and finally approved by two pulmonologists. The test-retest method was used to investigate the questionnaire's reliability. The questionnaire was used to assess the health status of 158 COPD patients with FEV1/FVC ratio≤ 0.7 or FEV1<80%, without exacerbation, cardiac disease, or recent hospitalization.

 The reliabilities of the first part (questions 1-7) and second part (questions 8-14) of the questionnaire was 0.64 and 0.90, respectively. The current health was good, fair, poor, and very poor in 7.6%, 22.2%, 44.9%, 22.8%, and 2.5% of the patients, respectively. The mean± standard deviation (SD) scores calculated for symptoms, activity, and impact were 54.216±23.725, 41.477±24.996, and 37.482±26.390, and the total score was 133.176±69.284.

 The Persian version of the SGRQ-C was valid and reliable. The patients with COPD at our center had a good health status.

Respiratory disorders affect the personality traits and quality of sleep-in pulmonary pa-tients. The purpose of this study was to compare sleep quality and personality factors in patients with chronic obstruc-tive pulmonary disease (COPD) and healthy individuals.

In this cross-sectional project, 70 participants with convenience sampling were enrolled. These participants were divided into 2 groups. Group 1 consisted of 35 patients with respiratory disorders who were admitted to Firoozgar Hospital, Tehran, Iran, to take pulmonary care and group 2 consisted of 35 healthy people from the patients’ families. All were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Sixteen Personality Factor Questionnaire (16PF). Statistical analysis was performed by SPSS.

There was a significant difference between personality factors in two groups, so that mean of B (reasoning), C (emotional stability), E (dominance), F (liveliness), G (rule consciousness), H (social boldness, and Q3 (perfectionism) factors in the healthy group was higher than the patient group and the mean of M (abstractedness), O (apprehension), and Q4 (tension) factors in the patient group was higher than the healthy group. The mean difference in sleep quality was also significant (P < 0.01) and indicated that patient group had more sleep problems and their sleep quality was poor.

In order to help patients with pulmonary disorders, evaluation of personality status and quality of sleep should be considered. This consideration can help the patients to receive better treatment and their psychological and physical problems would be considered simultaneously.

 The exact description of asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS) is uncertain. This study aims to determine the frequency and symptoms of ACOS and to verify certain risk factors associated with ACOS.

 Severe asthmatic patients with and without ACOS above 40 years old participated in this cross-sectional study. The receiver operating curve analysis (ROC) was used to assess the best cutoff values of age, body mass index (BMI), and spirometric data to distinguish asthma patients with overlap syndrome from asthma patients without overlap syndrome. Univariable and multivariable binary logistic regression was used to determine demographic and clinical factors that were associated with ACOS and asthma.

 Of the 88 patients, 46 (52.2%) had ACOS and 42 (47.7%) had just severe asthma. The mean age of ACOS patients (Sd) was 54.91(12.57) years and in asthma-only patients was 48.69 (13.51). The ROC analysis for age and BMI showed that age ⩾ 49 years and BMI ⩾ 27 kg/m2 were the best predictors of ACOS in this study. Spirometry data showed that the forced vital capacity (FVC) (lit) > 2.16, forced expiratory volume in the first second (FEV1) > 69, FEV1 / FVC > 96.5, and FVC (%) > 63 cut points could be used to determine the diagnostic criteria between ACOS and asthma only, respectively. Multivariate modeling showed that among the demographic and clinical variables, only age over 49 years (odds ratio [OR], 3.53 [95% CI, 1.07-11.63] p = 0.025) and living in a big city (OR, 7.42 [95% CI, 1.75-31.49] p = 0.007) were significant.

 Age over 49 and BMI above 27 have a significant association with ACOS. Also, living in a big city is considered to be another risk factor for ACOS compared with asthma. Spirometry can help distinguish ACOS from severe asthma in this study.

During the past three decades, the Middle East has been one of the important areas that has experienced three major viral epidemics. COVID-19 as a pulmonary disease was first reported in China in the early third decade of the 21st century and quickly infected Asian countries, the Middle East, and then the entire world. The pandemic has caused widespread financial damage and life-threatening, but the exact extent of the damage is still unclear. The high prevalence of COVID-19 has created fright in public societies and disrupted many everyday tasks. The disease has various clinical symptoms that are updated daily by different researchers. Many countries that do not have the sufficient tools to prevent, identify and treat the virus still have major challenges in controlling the disease. The Middle East, where Iran has been under heavy economic and political sanctions, has faced widespread disease and deaths due to lack of facilities. These challenges affected not only Iran but also many neighboring countries and other related countries. Recently, concerns have doubled with the outbreak of the delta variant-COVID-19 because the risk of hospitalization and the rate of spread are higher. The purpose of this review was to present the latest on the symptoms, pathogenicity and host immune responses, Etiology and Epidemiology, transmission routes and impact of Middle Eastern countries, especially Iran, and its role in the spread of the disease.

Chronic obstructive pulmonary disease (COPD) is a common medical problem. The improper implementation of inhaler techniques thatare used in such patients leads to the reduced effect of medicines. This study was conducted to evaluate the correct use of various inhalers among COPD patients. This observational, cross-sectional study was carried out on 96 patients with COPD aged over 40 years. The samples were selected using asystematic random samplingmethod from patients with COPD referring to the clinics of Ghaem and Imam Reza hospitals, Mashhad, Iran, from March 2018 to March 2019. The subjects were informed that their participation in the study was voluntary. These cases were under the treatment of using at least one inhaled medicine for a month or more. The adopted technique of applying four types of inhalers was evaluated by a standard checklist. The patients' performance scores of all procedures were recorded, and the collected data were analyzed in SPSS software (version 16). Our study revealed that more than 98% of patients used metered-dose inhaler (MDI) spray (P=0.05). The patients' scores on the correct use of MDI, Diskus, Turbuhaler, and HandiHaler inhalers were estimated at 68, 77, 87, and 90%, respectively. The most common mistakes in using MDI and HandiHaler inhalers were related to the 'holding the breath' and "taking a deep inhale' steps after using the inhaler, respectively. Physicians must evaluate and modify the use of inhalers in every COPD patient. It is recommended that easy-to-use inhalers, such as HandiHaler, be prescribed for such patients.

Chronic obstructive pulmonary disease (COPD) is a major noncommunicable respiratory disease with diverse pulmonary and external pulmonary clinical manifestations. This disease is one of the leading causes of mortality in the world, and about 1% of the adult population suffers from COPD.

The aim of this study was to assess the effect of Montelukast on the serum level of inflammatory factors in patients with chronic obstructive pulmonary disease (COPD).

In a randomized placebo-controlled trial, 74 patients with COPD with stable conditions were followed for two months after a random assignment to the placebo and montelukast (10 mg/d) groups. All patients continued their treatment protocol irrespective of their group to evaluate the effects of the addition of montelukast on serum levels of common inflammatory factors, such as Tumor Necrosis Factor alpha (TNF-α), C-reactive protein (CRP), and Interleukin 18 (IL-18) in COPD patients. SPSS 18 software was used for data analysis. Results of quantitative data were reported as mean±standard deviation or median (interquartile range) and qualitative data as frequency (percentage). If the data distribution was normal, the paired t-test was used to compare the mean before and after and using an independent t-test to compare the mean changes between the two groups. The Mann-Whitney U test and Wilcoxon signed-rank test were also used if the data were not assumed to be normal. A P < 0.05 was considered as the level of significance.

At baseline, there were no significant differences in laboratory studies between the two groups. After two months of intervention, there was no evidence of decreased TNF-α and CRP in the montelukast group. IL-18 levels were not significantly different at the end of the study between the two groups (P = 0.23), but it had a decreasing trend in the montelukast group (from 20.25 ± 5.98 ng/ml to 16.19 ± 4.17 ng/ml, P < 0.001).

Montelukast complementary therapy in COPD patients only improve the serum IL-18 levels and has not a reducing effect on the level of TNF-α and CRP evidenced by keeping their trend from baseline to the end of the study

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death. Restless Legs Syndrome (RLS) is associated with many systemic diseases. RLS is found in many patients with COPD. There is paucity of data on this topic from India. The aim is to find the prevalence of RLS in COPD patients and its distribution in study population with respect to various demographic and clinical characteristics. Correlation between severity of RLS and COPD severity was also aimed to be evaluated. Prospective, observational study conducted in a tertiary care institute over a period of 12 months. After fulfilling the inclusion criteria the patients were categorized according to the severity of COPD using the GOLD guidelines. Diagnosis and severity of RLS was evaluated using IRLSSG criteria. Prevalence and association of RLS with COPD and its demographic and clinical characteristics was evaluated. A total of 294 patients were taken which included 229 (77.9%) males and 65 females (22.1%). Mean age was 62.05 ± 10.32 years. Smoking was a more common risk factor among the patients (85.7%). 110 patients were diagnosed with RLS. A statistical significant association was found between duration of COPD and RLS (p value =0.001) and also between severity of COPD and RLS (p value=0.001). A significant positive correlation (r=0.395, p value= 0.001) between severity of COPD and RLS. Forty two (87.5%) patients with definite RLS had stage D COPD. Degree of obstruction of airways showed a statistical significant association with prevalence of RLS (p value=0.001).   RLS showed increased prevalence in COPD patients making it crucial to screen all the COPD patients for symptoms of RLS and if required to treat the symptoms, thus improving the quality of life.

Nebulized budesonide has been long used in chronic obstructive pulmonary disease (COPD)exacerbation. This study aimed to compare the effectiveness of nebulized budesonide (NB) versus oral pred-nisolone (OP) in increasing peak expiratory flow rate (PEFR) of COPD patients in emergency department (ED).

Patients with COPD exacerbation, referring to ED were enrolled in this randomized trial study. In thefirst group, NB 0.5 mg every 30 minutes till three doses, placebo tablet, and standard treatment was adminis-tered. In the second group, nebulized normal saline, OP tablet 50 mg, and standard treatment were adminis-tered. Patients’ demographic data, vital signs, PEFR, venous blood gas (VBG) analysis, disposition, and patientand physician satisfaction were all collected and compared between the two groups.

43 patients inthe NB group and 41 patients in the OP group were evaluated. The two groups had similar age (p=0.544) andgender (p=0.984) distribution, duration of illness (p=0.458), and baseline PEFR (p=0.400). 12 and 24 hours aftertreatment, significant increase in PEFR in the NB and OP groups were observed (p=0.032 and 0.008; respec-tively). The upward trend of PEFR in NB group was significantly better than that of OP group during 24 hoursof treatment (p=0.005). Vital signs and VBG results showed no significant differences between the two groupsduring the studied time interval.

NB, compared to OP, could more effectively increase PEFR andameliorate disease severity of patients with COPD exacerbation at 12 and 24 hours after treatment in ED

Gaucher Disease is an autosomal recessive lysosomal storage disease. Pulmonary involvement in Gaucher Disease is rare and often seen in the severe form of the disease with the worst outcome.

A 30-year-old man and known case of Gaucher Disease presented to our clinic with history of progressive dyspnea since 8 months ago. Pulmonary function test showed restrictive pattern. Chest CT scan revealed diffuse bilateral interlobular septal thickening and small interstitial nodules with ground glass opacities in lower lobes.

Patients with Gaucher Disease that present with progressive dyspnea may have a manifestation of interstitial or alveolar lung disease.

Diabetes mellitus is the most prevalent metabolic disorder. Previous related studies have shown that, lungs are target organs in diabetic micro-angiopathy. The present study was designed to investigate the spirometric indices in patients with type 2 diabetes referred to the outpatient clinic of Imam Hussein hospital in Shahroud, Iran.

This comparative study included 50 patients with type 2 diabetes and 50 non-diabetic subjects who were matched in terms of weight, age, and sex, and were referred to the Diabetes clinic of Imam Hussein hospital in Shahroud, Iran. MIR SPIROLAB III spirometer was used for spirometric tests to obtain FEV1, FVC, PEFR, and FEF 25-75. Decrease in these indices is determinant of pulmonary complications. Indices were compared between two groups. The relationships between some variables like glycated hemoglobin (HbA1c) and type of their treatment with the severity of spirometric disturbances were also assessed.

The average age was equal to 56.3 years old (with SD of 6.3 years) and 58.3 years old (with SD of 6.3 years), respectively in non-diabetic and diabetic group. Comparison of the FEV1, FVC, PEFR, and FEF 25-75 indices between diabetic and non-diabetic groups showed a significant difference (P.V<0.05). No significant difference was found in the FEV1/FVC ratio. According to the Pearson correlation formula, there was a significant association between decreased spirometric indices and increased concentration of Hb A1C (-.630, -.635 and-.374 for FEV1, FVC, and PEFR, respectively). There was no association between decreased concentration of FEV1/FVC and increased HbA1c.

The findings of the study revealed that, there was a significant decrease in pulmonary functions in the diabetic group. Impaired pulmonary function can be detected in early stages of diabetes and studying the pulmonary function can be easily preformed. Accordingly, screening lungs function should be carried out regularly, as well as integrating in other routine examinations and screening tests.